Chapter 24 Heart Failure Drugs Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
Chapter 17 Substance Abuse Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
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Transcript of Chapter 17 Substance Abuse Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
Chapter 17
Substance Abuse
Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
Physical dependence Psychologic dependence Habituation Addiction
Substance Abuse: Leads to Dependence
2Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
Opioids Stimulants
Methamphetamine Methylenedioxymethamphetamine (MDMA,
“ecstasy”) Cocaine
Depressants Benzodiazepines Barbiturates Marijuana
Commonly Abused Substances
3Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
Alcohol Anabolic steroids Dextromethorphan Lysergic acid diethylamide (LSD) Nicotine Phencyclidine (PCP)
Commonly Abused Substances
4Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
Opioids
opium heroin
(diacetylmorphine) morphine codeine hydromorphone
hydrocodone meperidine oxycodone propoxyphene methadone
Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 5
Also known as narcotics Opium and heroin are Schedule I Most others are Schedule II because of their
high potential for abuse Often abused because of their ability to
produce euphoria
Opioids (cont’d)
6Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
Produce analgesia, drowsiness, euphoria, tranquility, other mood alterations
Affect areas outside the central nervous system (CNS) Skin, GI tract, GU tract
Normally used to: Relieve pain, reduce cough, relieve diarrhea, and
induce anesthesia
Opioids (cont’d)
7Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
Heroin Injected (“mainlining” or “skin popping”) Sniffed (“snorted”) Smoked
Causes a brief “rush,” followed by a few hours of a relaxed, contented state
Large doses can stop respirations Methadone
Opioids (cont’d)
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Central nervous system Diuresis Miosis Convulsions Nausea, vomiting Respiratory depression
Opioids: Adverse Effects
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Non–central nervous system Hypotension Constipation Urinary retention Flushing of the face, neck, and upper thorax Sweating, urticaria, and pruritus
Opioids: Adverse Effects (cont’d)
10Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
Peak period: 1 to 3 days Duration: 5 to 7 days Signs
Drug seeking, mydriasis, diaphoresis, rhinorrhea, lacrimation, diarrhea, elevated BP and pulse
Symptoms Intense desire for drug, muscle cramps, arthralgia,
anxiety, nausea, vomiting, malaise
Opioid Drug Withdrawal
11Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
Block opioid receptors so that use of opioid drugs does not produce euphoria
Naltrexone—an opioid antagonist Vivitrol—injectable form of naltrexone Naloxone combined with buprenorphine
(Subutrex) or used alone (Suboxone)
Opioid Drug Withdrawal: Treatment
12Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
Elevation of mood Reduction of fatigue Increased alertness Invigorated aggressiveness
Stimulants
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Amphetamines Methamphetamine MDMA (“ecstasy”)
cocaine methylphenidate (Ritalin)
Stimulants
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Stronger effects than other amphetamines Pill form Powder form: snorted or injected Crystallized form:
Also known as “ice,” “crystal,” “glass,” “crystal meth” Smokable More powerful Sales of over-the-counter (OTC) pseudoephedrine
are now regulated
Methamphetamine
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Usually prepared in secret home laboratories More calming effects than other amphetamine
drugs Usually taken by pill “Raves”
Methylenedioxymethamphetamine (MDMA, “ecstasy,” or “E”)
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From the leaves of the coca plant Snorted or injected intravenously Highly addictive—physical and psychologic
dependence Powdered form
Also called “dust,” “coke,” “snow,” “flake,” “blow,” “girl”
Crystallized form (smoked) Also called “crack,” “freebase rocks,” “rock”
Cocaine
17Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
Stimulants: Adverse Effects
CNS Restlessness Syncope (fainting) Tremor Hyperactive reflexes Talkativeness Irritability Insomnia Fever Euphoria
Confusion Aggression Increased libido Anxiety Delirium Paranoid
hallucinations Suicidal or homicidal
tendencies
Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 18
Cardiovascular Headache Chilliness Pallor or flushing Palpitations Tachycardia Cardiac dysrhythmias Anginal pain Hypertension or hypotension Circulatory collapse
Stimulants: Adverse Effects
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Stimulants: Adverse Effects
Gastronintestinal Dry mouth Metallic taste Anorexia Nausea Vomiting Diarrhea Abdominal cramps
Fatal hyperthermia
Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 20
Death results from: Convulsions Coma Cerebral hemorrhage
May occur during periods of intoxication or withdrawal
Stimulant Overdose
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Peak period: 1 to 3 days Duration: 5 to 7 days Signs
Social withdrawal, psychomotor retardation, hypersomnia, hyperphagia
Symptoms Depression, suicidal thoughts and behavior,
paranoid delusions No specific pharmacologic treatments
Stimulant Withdrawal
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Drugs that relieve anxiety, irritability, and tension
Used to treat seizure disorders and induce anesthesia
Two main pharmacologic classes: Benzodiazepines (flunitrazepam) Barbiturates
Marijuana (“pot,” “grass,” “weed”)
Depressants
23Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
CNS Drowsiness, sedation, loss of coordination,
dizziness, blurred vision, headaches, and paradoxical reactions
Gastronintestinal Nausea, vomiting, constipation, dry mouth, and
abdominal cramping Pruritus and skin rash “Amotivational” syndrome
Depressants: Adverse Effects
24Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
Peak period 2 to 4 days for short-acting drugs 4 to 7 days for long-acting drugs
Duration 4 to 7 days for short-acting drugs 7 to 12 days for long-acting drugs
Signs Increased psychomotor activity; agitation;
hyperthermia; diaphoresis; delirium; convulsions; elevated BP, pulse rate, and temperature; others
Depressants Withdrawal
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Symptoms Anxiety, depression, euphoria, incoherent thoughts,
hostility, grandiosity, disorientation, hallucinations, suicidal thoughts
Treatment involves tapering of the drug over a course of a 7 to 10 or 10 to 14 days
Depressants Withdrawal (cont’d)
26Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
Classroom Response Question
Which drug will the nurse anticipate administering to a patient experiencing benzodiazepine overdose?
A. flumazenil
B. naltrexone
C. Vivitrol
D. flunitrazepam
Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 27
More accurately known as ethanol (ETOH) Causes CNS depression by dissolving in lipid
membranes in the CNS Few legitimate uses of ethanol and alcoholic
beverages Used as a solvent for many drugs
Alcohol (Ethanol)
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CNS depression Respiratory stimulation or depression Vasodilation, producing warm, flushed skin Increased sweating Diuretic effects
Ethanol: Drug Effects
29Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
Nutritional and vitamin deficiencies (especially B vitamins) Wernicke’s encephalopathy Korsakoff’s psychosis Polyneuritis Nicotinic acid deficiency encephalopathy
Seizures Alcoholic hepatitis, progressing to cirrhosis Cardiomyopathy
Effects of Chronic Ethanol Ingestion
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Fetal alcohol syndrome (FAS) Craniofacial abnormalities CNS dysfunction Prenatal and postnatal growth retardation
Effects of Chronic Ethanol Ingestion (cont’d)
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Signs and symptoms Elevated blood pressure, pulse rate, and
temperature Insomnia Tremors Agitation
Classified as mild, moderate, and severe
Ethanol Withdrawal
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Classroom Response Question
A patient with a diagnosis of delirium tremens is admitted to the acute care facility. Which finding does the nurse expect upon assessment of the patient?
A. Hyperthermia
B. Hypotension
C. Bradycardia
D. Somnulence
Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 33
Benzodiazepines are the treatment of choice diazepam (Valium), lorazepam (Ativan), or
chlordiazepoxide (Korsakoff’s psychosis) Dosage and frequency depend on severity
For severe withdrawal, monitoring in an intensive care unit is recommended
Ethanol Withdrawal Treatment
34Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
disulfiram (Antabuse) Acetaldehyde syndrome
naltrexone acamprosate (Campral)
Newest treatment Counseling
Individual Alcoholics Anonymous
Treatment for Alcoholism
35Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
Classroom Response Question
Which statement does the nurse include when teaching a patient about disulfiram (Antabuse) therapy?
A.“Disulfiram (Antabuse) will cure your alcoholism if you take it as directed.”
B.“If you drink alcohol after taking disulfiram (Antabuse), your blood pressure will get very high.”
C.“You cannot drink alcohol for at least 3 or 4 days after taking disulfiram (Antabuse).”
D.“If you miss a dose of disulfiram (Antabuse), double the dose the next time it is due.”
Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 36
Many smoke to “calm nerves” Releases epinephrine, which creates
physiologic stress rather than relaxation Tolerance develops Physical and psychologic dependency Withdrawal symptoms occur if stopped No therapeutic uses 200 known poisons present in cigarette smoke
Nicotine
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Transient stimulation of autonomic ganglia Followed by more persistent depression of all
autonomic ganglia CNS and respiratory stimulation, followed by
CNS depression Increased heart rate and BP Increased bowel activity
Nicotine:Drug Effects
38Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
Manifested by cigarette craving Irritability, restlessness, decreased heart rate and BP
Cardiac symptoms resolve in 3 to 4 weeks, but cigarette craving may persist for months or years
Nicotine Withdrawal
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Treatments provide nicotine without the carcinogens in tobacco : Nicotine transdermal system (patch) Nicotine polacrilex (gum) Inhalers Nasal spray
Nicotine Withdrawal Treatment
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bupropion (Zyban) may be prescribed to aid in smoking cessation First nicotine-free prescription medicine to treat
nicotine dependence varenicline (Chantix)
Stimulates nicotine receptors
Nicotine Withdrawal Treatment
41Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
Classroom Response Question
The nurse is explaining the differences between transdermal nicotine and nicotine gum programs. Which statement by the nurse is correct?
A. “The nicotine patch will give you quick relief from cravings.”
B. “Chewing the gum rapidly will release an immediate dose of nicotine.”
C. “It seems that patients have better treatment compliance with the gum than the patch.”
D. “The dose of nicotine in the gum is approximately twice the dose the average smoker receives in one cigarette.”
Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 42
Assessments should include nonjudgmental and open-ended questions about substance abuse
Be observant for clues to substance abuse so as to avoid withdrawal symptoms
The most dangerous substances in terms of withdrawal are CNS depressants such as barbiturates, benzodiazepines, and alcohol
Establish therapeutic rapport, and use empathy toward the patient
Nursing Implications
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Assessment tools for substance abuse CAGE Alcoholism Screening Test Adapted to
Include Drugs (CAGE-AID) Substance Abuse Subtle Screening Inventory
(SASSI) Michigan Alcoholism Screening Test Geriatric
version (MAST-G) Problem Oriented Screening Instrument for
Teenagers (POSIT)
Nursing Implications (cont’d)
44Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
Patient safety is of utmost importance at all times during patient care but especially when the patient is experiencing the signs and symptoms of withdrawal
Provide monitoring and support as needed throughout the withdrawal process
Educate the patient and family members or significant others about the recovery process
Emphasize that recovery is lifelong
Nursing Implications (cont’d)
45Copyright © 2014 by Mosby, an imprint of Elsevier Inc.